Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2199 | OR |
N | 2251H1200X | Hand | 1021100023 | OR |
NPI | 1043258080 |
---|---|
Provider Name | Mrs. Kay Ellen Blachly |
First Address | Salem, OR 97301-4257 |
Second Address | Keizer, OR 97303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 25/04/2019 |